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Presented by Ralph Hruban, M.D. and prepared by Natasha Rekhtman, M.D., Ph.D.
Case 1: This middle-aged woman had known metastases to the liver and lungs.
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1. Question
Week 224: Case 1
This middle-aged woman had known metastases to the liver and lungs. Endoscopy was performed in search of a primary site and a nodule was biopsied.images/taxol1.jpg
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Answer: Taxol toxicity
Histology: Numerous bizarre mitotic figures are present in the epithelium. These include ring mitoses in which the chromosomes are displaced to the periphery of the cells.
Discussion: Taxol is an anti-neoplastic agent derived from the bark of the Pacific yew tree. Taxol stabilizes microtubules and can cause, as seen in this case, distinctive “ring” mitoses in which the chromosomes are displaced to the periphery of the cells. This appearance is presumably caused by polymerized microtubules with the chromosomes sitting at the ends of the microtubules (like pieces of meat on a skewer). In this case the pathologist was able to suggest that the patient was receiving Taxol, and indeed she was. Similar mitoses can be seen with colchicine toxicity.
Reference(s):
– Hruban, RH et al. Taxol toxicity. Epithelial necrosis in the gastroesophageal tract associated with polymerized microtubule accumulation and mitotic arrest. Cancer 63:1944-1950, 1989.Incorrect
Answer: Taxol toxicity
Histology: Numerous bizarre mitotic figures are present in the epithelium. These include ring mitoses in which the chromosomes are displaced to the periphery of the cells.
Discussion: Taxol is an anti-neoplastic agent derived from the bark of the Pacific yew tree. Taxol stabilizes microtubules and can cause, as seen in this case, distinctive “ring” mitoses in which the chromosomes are displaced to the periphery of the cells. This appearance is presumably caused by polymerized microtubules with the chromosomes sitting at the ends of the microtubules (like pieces of meat on a skewer). In this case the pathologist was able to suggest that the patient was receiving Taxol, and indeed she was. Similar mitoses can be seen with colchicine toxicity.
Reference(s):
– Hruban, RH et al. Taxol toxicity. Epithelial necrosis in the gastroesophageal tract associated with polymerized microtubule accumulation and mitotic arrest. Cancer 63:1944-1950, 1989.
